Youth Academy Information & Registration

Personal details *

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Last

Parents confirmation (Required for persons under 14 years of age at date of application for membership)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone for text alerts and contact

Emergency Contact Number *

Email *

Phone

Multiple Choice

Male
Female
Gender Neutral

Date of Birth

School

Youth Academy Membership (under 19 @ 1st April) to March 31st 2027 *

Price: $40.00

Internet Banking. (please include your name as reference) 38-9025-0703301-00 (Manawatu Blokart Club fees includes NZBAI affiliation fee)

Checkboxes *

I/we agree to comply with the rules and by-laws of Manawatu Blokart Club & New Zealand Blokart Association Inc, (NZBAI). Should I cause any injury or damage to myself, my associates, any other patrons, to any members of the public or any property. I waiver any form of liability to the Manawatu Blokart Club executive, members and associates of Manawatu Blokart Club against all actions, claims or expenses in respect of any such injury or damage.
I/we consent to the collection of the above details by Manawatu Blokart Club & NZBAI for the purpose of membership records, sponsors and other funding agencies, the news media or other organisations for the development of Blokart sailing and for the benefit of Manawatu Blokart Club & NZBAI members.

The Manawatu Blokart Club & NZBAI requires the information on this membership form for its own records, administration and statistical purposes, the promotion of Blokart in the news media, the development of Blokart sailing and for the benefit of Manawatu Blokart Club & NZBAI members. Sponsors and other funding agencies may require non-identifying statistical information. Manawatu Blokart Club & NZBAI may also be required to pass your information on for its membership of relevant organisations. Existing relevant organisations are: SPARC – Sport and Recreation NZ. IBRA – International Blokart Racing Association. Affiliated clubs. Please note the Manawatu Blokart Club and NZBAI will not sell or pass on member information to anyone else.

Parents Confirmation (Required for persons under 14 years of age at date of application for membership)

I agree to my child participating in the Blokart Youth academy and agree to the conditions of the registration form.

Parent or Guardian's Name *

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Last

Date / Time

Parent or Guardian Phone